Healthcare Provider Details

I. General information

NPI: 1558696187
Provider Name (Legal Business Name): METROCARE WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11040 EAST FWY
HOUSTON TX
77029-1931
US

IV. Provider business mailing address

11040 EAST FWY
HOUSTON TX
77029-1931
US

V. Phone/Fax

Practice location:
  • Phone: 305-763-4822
  • Fax:
Mailing address:
  • Phone: 305-763-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EGHOSA AIDEYAN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 305-763-4822